County Health Rankings and Roadmaps County Equivalent Measures - 2015 Community Epidemiology and Health Planning Unit March 2015
Health Oak Forest Health Center 15900 S. Cicero Avenue Oak Forest, Il 60452 Terry Mason, MD, F.A.C.S. Chief Operating Officer Kiran Joshi, MD, MPH Senior Medical Officer Steven M. Seweryn, EdD, MPH Director, Community Epidemiology and Health Planning Unit Buddy R. Bates, MSPH Assistant Director, Epidemiology Program Office
The 2015 annual County Health Rankings & Roadmaps report (www.countyhealthrankings.org), a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, ranks U.S. counties in every state on various health outcomes, health factors, social and economic conditions, and the physical environment. The Rankings look at a variety of measures that affect health such as the rate of people dying before age 75, food insecurity, rates of smoking, obesity and teen births, access to care, high school graduation rates, unemployment, income inequality, food insecurity, community safety, air and water quality, and housing. The county health rankings report does not examine data at the sub-county level. The County Department of Public Health (CCDPH) identified indicators from the County Health Rankings for which local data existed and were comparable (see Appendix A: Statistical Notes and Definitions). Following similar indicator definitions and analytical methodologies used in the County Health Rankings reports, CCDPH calculated local estimates for suburban cook county (SCC). Results can be found in Table 2: 2015 County Health Rankings Equivalent Measures. Due to data not being readily available for several key indicators, SCC data is unranked. However, results of the calculations were categorized based on the 2015 United States National Averages found in the annual County Health Rankings and Roadmaps report. The three categories were at or better than the National Average (<10%), 10%-49% worse than the National Average and at least 50% worse than the National Average (see Table 1 below). Table 1: Comparison to National Average At or Better 10% - 49% worse At least 50% worse than the National Average than the National Average than the National Average < 10% 10% - 49% 50% Premature death rate Physical inactivity Excessive drinking Poor or fair health Unemployment Poor physical health days Long commute-driving alone Poor mental health days Low birth weight Adult smoking Adult obesity Alcohol-impaired driving deaths Sexually transmitted infections (Chlamydia incidence rate) Teen births Uninsured High school graduation Some college Children in poverty Income Inequality Children in single-parent households Violent crimes Injury deaths Severe housing problems Driving alone to work Page 1 of 7
Table 2: 2015 County Health Rankings Equivalent Measures Measure Description National Average Illinois * HEALTH OUTCOMES Premature death Years of potential life lost before age 75 per 100,000 population 6,622 6,349 6,794 6,222 Poor or fair health % of adults reporting fair or poor health 16% 15% 17% 18% Poor physical health days Average # of physically unhealthy days reported in past 30 days 3.7 3.4 3.5 3.2 Poor mental health days Average # of mentally unhealthy days reported in past 30 days 3.4 3.3 3.5 3.2 Low birthweight % of live births with low birthweight (< 2500 grams) 8.0% 8.4% 9.1% 8.3% HEALTH FACTORS HEALTH BEHAVIORS Adult smoking % of adults who are current smokers 20% 18% 18% 22% Adult obesity % of adults that report a BMI 30 27% 27% 25% 27% Food environment index Index of factors that contribute to a healthy food environment, (0 10) 7.4 7.8 7.6 n.a. Physical inactivity % of adults aged 20 and over reporting no leisure time physical 23% 23% 21% 27% activity Access to exercise opportunities % of population with adequate access to locations for physical activity 85% 89% 99% n.a. Excessive drinking % of adults reporting binge or heavy drinking 15% 20% 21% 32% Alcohol impaired driving deaths % of driving deaths with alcohol involvement 31% 37% 39% 32% Sexually transmitted infections # of newly diagnosed chlamydia cases per 100,000 population 453 526 725 389 Teen births # of births per 1,000 female population ages 15 19 37 35 42 30 CLINICAL CARE Uninsured % of population under age 65 without health insurance 17% 15% 18% 15% Primary care physicians Ratio of population to primary care physicians 1,342:1 1,266:1 1,088:1 n.a. Dentists Ratio of population to dentists 1,583:1 1,453:1 1,250:1 n.a. Mental health providers Ratio of population to mental health providers 529:1 604:1 505:1 n.a. Preventable hospital stays # of hospital stays for ambulatory care sensitive conditions per 1,000 59.3 65.0 60.0 n.a. Medicare enrollees Diabetic monitoring % of diabetic Medicare enrollees ages 65 75 that receive HbA1c 85% 85% 83% n.a. monitoring Mammography screening % of female Medicare enrollees ages 67 69 that receive 63.0% 64.4% 62.0% n.a. mammography screening SOCIAL AND ECONOMIC FACTORS High school graduation % of ninth grade cohort that graduates in four years 80% 82% 78% 87% Some college % of adults ages 25 44 with some post secondary education 63.0% 66.7% 67.0% 67.0% Unemployment % of population aged 16 and older unemployed but seeking work 7.0% 9.2% 9.6% 9.1% Children in poverty % of children under age 18 in poverty 22% 21% 26 % 17% Income inequality Ratio of household income at the 80th percentile to income at the 4.6 4.8 4.8 4.6 20th percentile Children in single parent % of children that live in a household headed by single parent 33% 32% 38% 33% households Social associations # of membership associations per 10,000 population 9.4 9.9 7.0 n.a. Violent crime # of reported violent crime offenses per 100,000 population 392 430 631 267 Injury deaths # of deaths due to injury per 100,000 population 59.3 50.0 46.0 42.0 PHYSICAL ENVIRONMENT Air pollution particulate matter Average daily density of fine particulate matter in micrograms per 11.1 12.5 13.1 n.a. cubic meter (PM2.5) Drinking water violations % of population potentially exposed to water exceeding a violation 7% 2% 1% n.a. limit during the past year Severe housing problems % of households with overcrowding, high housing costs, or lack of 19% 19% 24% 20% kitchen or plumbing facilities Driving alone to work % of workforce that drives alone to work 76% 74% 63% 75% Long commute driving alone Among workers who commute in their car alone, % commuting 33% 40% 49% 45% > 30 minutes * County Measures Compared to the National Average < 10% At or better than national average 10-49% 10-49% worse than the national average 50% At least 50% worse than the national average Page 2 of 7
Appendix A: Statistical Notes and Definitions County Health Rankings Equivalent Measures Health Outcomes Mortality Premature death National, State, and County National Center for Health Statistics (NCHS), Division of Vital Statistics, Mortality public-use data, 2010-2012. County Illinois Department of Public Health, County Death Pull File, 2010-2012 Premature death before age 75; Age adjusted, rate per 100,000. 6,622 6,349 6,794 6,222 Morbidity Poor or fair health Poor physical health days Poor mental health days Low birthweight National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data, Illinois Department of Public Health, County Birth Pull File, 2005-2011. Percent of adults, 18 years and over, who rate their health fair or poor. The measure is age-adjusted to the 2000 U.S. population. Average number of days in the past 30 days, adults 18 years and over report that their physical health was not good. The measure is age-adjusted to the 2000 U.S. population. Average number of days in the past 30 days, adults 18 years and over report that their mental health was not good. The measure is age-adjusted to the 2000 U.S. population. Percent of all live births for which the infant weighed less than 2,500 grams (approximately 5 lbs., 8 oz.). 16% 15% 17% 18% 3.7 3.4 3.5 3.2 3.4 3.3 3.5 3.2 8.0% 8.4% 9.1% 8.3% Health Factors Health Behaviors Adult smoking Percent of adults, 18 years and over, that currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime. 20% 18% 18% 22% Adult obesity Prevention (CDC), National Center for Chronic Disease Prevention and Promotion, National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System (BRFSS) 2011. http://www.cdc.gov/diabetes/atlas/coun tydata/atlas.html Percent of the adult population (age 20 and older) that has a body mass index (BMI) greater than or equal to 30 kg/m 2. 27% 27% 25% 27% Page 3 of 7
Food Environment Index USDA Food Environment Atlas (2012). http://www.ers.usda.gov/dataproducts/food-environment-atlas/dataaccess-and-documentationdownloads.aspx#.utmnibdnbiu; Map the Meal Gap from Feeding America (2011). http://feedingamerica.org/hunger-inamerica/hunger-studies/map-the-mealgap.aspx n.a. The food environment index is a measure ranging from 0 (worst) to 10 (best) which equally weights two indicators: Limited access to healthy foods estimates the proportion of the population who are low income and do not live close to a grocery store. Living close to a grocery store is defined differently in rural and non-rural areas; in rural areas, it means living less than 10 miles from a grocery store whereas in non-rural areas, it means less than 1 mile. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size. Food insecurity estimates the proportion of the population who did not have access to a reliable source of food during the past year. A model was created using information from the Current Population Survey, Bureau of Labor Statistics, and American Community Survey. 7.4 7.8 7.6 n.a. Physical inactivity Prevention (CDC), National Center for Chronic Disease Prevention and Promotion, National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System (BRFSS) 2011. http://www.cdc.gov/diabetes/atlas/coun tydata/atlas.html Percent of adults aged 20 and over reporting no leisure time physical activity. 23% 23% 21% 27% Access to exercise opportunities OneSource Global Business Browser, n.a. Delorme map data, ESRI, & US Census Tigerline Files (2010 & 2013) are combined in ArcGIS to create the measure. The OneSource Global Business Browser, for a fee, provides access to robust, integrated business intelligence, including corporate families, industries, key executives and financial data. The DeLorme Map Mart and ESRI public use GIS data provide geocoded, projected data on parks at the local, state and national level across the US. US Census Tigerline files are spatial extracts from the Census Bureau's MAF/TIGER database, containing features such as roads, railroads, rivers, as well as legal and statistical geographic areas. The percentage of individuals in a county who live reasonably close to a location for physical activity. Locations for physical activity are defined as parks or recreational facilities. Parks include local, state, and national parks. Recreational facilities include businesses identified by the NAICS code 713940, and include a wide variety of facilities including gyms, community centers, YMCAs, dance studios and pools. Individuals who reside in a census block within a half mile of a park or within one mile of a recreational facility in urban areas (3 miles in rural areas) are considered to have adequate access to opportunities for physical activity. 85% 89% 99% n.a. Page 4 of 7
Excessive drinking Percent of adults, 18 years and over, that report either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men) drinks per day on average. 15% 20% 21% Percent of adults, 18 years and over, that report only binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days. Does not include heavy drinking. 32% Alcohol-impaired driving deaths Fatality Analysis Reporting System (2009-2013). FARS is a census of fatal motor vehicle crashes with a set of data files documenting all qualifying fatalities that occurred within the 50 States, the District of Columbia, and Puerto Rico since 1975. http://www.nhtsa.gov/fars Fatality Analysis Reporting System (2009-2013). FARS is a census of fatal motor vehicle crashes with a set of data files documenting all qualifying fatalities that occurred within the 50 States, the District of Columbia, and Puerto Rico since 1975. http://www.nhtsa.gov/fars The percentage of motor vehicle crash deaths with alcohol involvement. To qualify as a FARS case, the crash had to involve a motor vehicle traveling on a trafficway customarily open to the public, and must have resulted in the death of a motorist or a non-motorist within 30 days of the crash. 31% 37% 39% 32% Sexually transmitted infections Teen birth rate Prevention (CDC), National Center for Hepatitis, HIV, STD and TB Prevention, 2012 National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data Health, Sexually Transmitted Infection Surveillance, 2012. Illinois Department of Public Health, County Birth Pull File, 2005-2011. Chlamydia incidence (number of new cases reported) per 100,000 population. The number of births per 1,000 female population, ages 15-19. 453 526 725 389 37 35 42 30 Clinical Care Uninsured U. S. Census Bureau, Small Area Health Insurance Estimates, 2012. (U.S. Census Bureau, 2012 American Community Survey, Table B27001). U. S. Census Bureau, Small Area Health Insurance Estimates, 2012. (U.S. Census Bureau, 2012 American Community Survey, Table B27001). Percent of population under age 65 that has no health insurance coverage. 17% 15% 18% 15% Primary care physicians U.S. Department of Health and Human Services. Health Resources and Services Administration, Area Health Resource File, 2012. n.a. Ratio of population per primary care physician (includes practicing physicians M.D.'s and D.O.'s under age 75 specializing in general practice medicine, family medicine, internal medicine, and pediatrics). 1,342:1 1,266:1 1,088:1 n.a. Dentists U.S. Department of Health and Human Services. Health Resources and Services Administration, Area Health Resource File, 2013 n.a. Ratio of population per dentist. 1,583:1 1,453:1 1,250:1 n.a. Mental Health Providers CMS, National Provider Identification 2014 http://nppes.vivait.com/npi_files.html n.a. The ratio of the county population to the number of mental health providers including psychiatrists, psychologists, licensed clinical social workers, counselors, and advanced practice nurses specializing in mental health care. 529:1 604:1 505:1 n.a. Page 5 of 7
Preventable hospital stays Dartmouth Institute for Health Policy n.a. and Clinical Practice, Dartmouth Atlas of Health Care, 2012. http://www.dartmouthatlas.org/data/regi on/ Hospital discharge rate for ambulatory care-sensitive conditions per 1,000 Medicare enrollees. 59.3 65.0 60.0 n.a. Diabetic screening Dartmouth Institute for Health Policy n.a. and Clinical Practice, Dartmouth Atlas of Health Care, 2012. http://www.dartmouthatlas.org/data/regi on/ Percent of diabetic Medicare patients whose blood sugar control was screened in the past year using a test of their glycated hemoglobin (HbA1c) levels. 85% 85% 83% n.a. Mammography screening Dartmouth Institute for Health Policy n.a. and Clinical Practice, Dartmouth Atlas of Health Care, 2012. http://www.dartmouthatlas.org/data/regi on/ Percent of female Medicare enrollees age 67-69 that had at least one mammogram over a two-year period. 63% 64% 62% n.a. Social & Economic Factors High school graduation Some college Unemployment Children in poverty Data.gov, supplemented w/ National Center for Education Statistics (2011-2012). Community Survey, 5-year estimates, 2009-2013. Table B15001: Sex by age by educational attainment for the population 18 years and over - Universe: Population 18 years and over. U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, 2013. http://www.bls.gov/lau/ U. S. Census Bureau, Small Area Income and Poverty Estimates, 2013. Illinois State Board of Education, 2012 (Applies to IL, and ). http://www.isbe.state.il.us/assessment /report_card.htm Community Survey, 5-year estimates, 2009-2013. Table B15001: Sex by age by educational attainment for the population 18 years and over - Universe: Population 18 years and over. U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, 2013. http://www.bls.gov/lau/ The percent of the ninth grade cohort that graduates high school in four years. Percent of the U.S. population ages 25-44 with some post-secondary education, such as enrollment at vocational/technical schools, junior colleges, or four-year colleges. It includes individuals who pursued education following high school but did not receive a degree. Percent of the civilian labor force, age 16 and older, that is unemployed but seeking work. 2013 American Community Survey 1- Percent of children under age 18 living Year Estimates, Table S1701: Poverty below the Federal Poverty Line (FPL). Status in the Past 12 Months. 80% 82% 78% 87% 63% 67% 67% 67% 7.0% 9.2% 9.6% 9.1% 22% 21% 26% 17% Income Inequality Community Survey, 2009-2013. Community Survey, 2009-2013. Ratio of household income at the 80th percentile to the income at the 20th percentile 4.6 4.8 4.8 4.6 Children in single-parent households Community Survey, 2009-2013. Community Survey, 2009-2013. Percent of all children in family households that live in a household headed by a single parent (male or female head of household with no spouse present). 33% 32% 38% 33% Social associations County Business Patterns, 2012 n.a. Number of membership associations per 10,000 population Violent crime rate Federal Bureau of Investigation (FBI), Uniform Crime Report: Crime in the United States, 2010-2012. http://www.fbi.gov/statsservices/crimestats Federal Bureau of Investigation (FBI), Uniform Crime Report: Crime in the United States, 2010-2012 http://www.fbi.gov/statsservices/crimestats Violent crime is represented as an annual rate per 100,000 population. Violent crimes are defined as offenses that involve face-to-face confrontation between the victim and the perpetrator, including homicide, forcible rape, robbery, and aggravated assault. 9.4 9.9 7.0 n.a. 392 430 631 267 Page 6 of 7
Injury Deaths CDC WONDER mortality data 2008-2012. Illinois Department of Public Health, County Death Pull File, 2008-2012. Injury deaths is the death rate from intentional and unintentional injuries per 100,000 population. Deaths included are those with an underlying cause of injury (ICD-10 codes *U01-*U03, V01-Y36, Y85-Y87, Y89). 59.3 50.0 46.0 42.0 Physical Environment Air pollution - particulate matter Fine Particulate Matter data available n.a. on CDC WONDER are geographically aggregated daily measures of fine particulate matter in the outdoor air, spanning the years 2003-2008. PM2.5 particles are air pollutants with an aerodynamic diameter less than 2.5 micrometers. Reported measures are the daily measure of fine particulate matter in micrograms per cubic meter (PM2.5) (µg/m³), the number of observations, minimum and maximum range value, and standard deviation. Data are available by place (combined 48 contiguous states plus the District of Columbia, region, division, state, county), time (year, month, day) and specified fine particulate matter (µg/m³) value. County-level and higher data are aggregated from 10 kilometer square spatial resolution grids. (2011). The average daily amount of fine particulate matter in micrograms per cubic meter (PM2.5) in a county. Fine particulate matter is defined as particles of air pollutants with an aerodynamic diameter less than 2.5 micrometers. These particles can be directly emitted from sources such as forest fires, or they can form when gases emitted from power plants, industries and automobiles react in the air. 11.1 12.5 13.1 n.a. Drinking water violations The Safe Drinking Water Information n.a. System (SDWIS) contains information about public water systems and their violations of EPA's drinking water regulations, as reported to EPA by the states. These regulations establish maximum contaminant levels, treatment techniques, and monitoring and reporting requirements to ensure that water systems provide safe water to their customers. FY 2013-2014). The percentage of the population getting water from public water systems with at least one health-based violation during the reporting period. Health-based violations include Maximum Contaminant Level, Maximum Residual Disinfectant Level and Treatment Technique violations. 7% 2% 1% n.a. Severe housing problems Comprehensive Housing Affordability Strategy (CHAS) data (2007-2011). http://www.huduser.org/portal/datasets/ cp/chas/data_querytool_chas.html Comprehensive Housing Affordability Strategy (CHAS) data (2007-2011). http://www.huduser.org/portal/datasets /cp/chas/data_querytool_chas.html Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, or lack of kitchen or plumbing facilities. 19% 19% 24% 20% Driving alone to work American Community Survey 5-year estimates, 2009-2013. Table S0802. American Community Survey 5-year estimates, 2009-2013. Table S0802. The percentage of the workforce that primarily drives alone to work. 76% 74% 63% 75% Long commute - driving alone American Community Survey 5-year estimates, 2009-2013. Table S0802. American Community Survey 5-year estimates, 2009-2013. Table S0802. The proportion of commuters, among those who commute to work by car, truck, or van alone, who drive longer than 30 minutes to work each day. 33% 40% 49% 45% Page 7 of 7